Healthcare Provider Details

I. General information

NPI: 1205592722
Provider Name (Legal Business Name): SHAKER FUNCTIONAL REHAB, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2021
Last Update Date: 11/09/2021
Certification Date: 11/09/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11201 SHAKER BLVD STE 322
CLEVELAND OH
44104-3871
US

IV. Provider business mailing address

PO BOX 64
RICHFIELD OH
44286-0064
US

V. Phone/Fax

Practice location:
  • Phone: 216-721-9010
  • Fax: 216-586-6780
Mailing address:
  • Phone: 216-721-9010
  • Fax: 216-586-6780

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. ALEXIS FRANTZIS
Title or Position: OWNER
Credential: DC
Phone: 216-721-9010